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TEMPORARY FOOD VENDOR’S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to 1.1. Name of Event: 2. 7s g/oAddress: Phone: 3.List food to be sold or given to the public: 4. 5. Other (specify): 6. 7. 8.I am providing an accurate probe thermometer to 9. meats, tamales, cooked beans, rice, Page 7 of 11 TEMP EVENT APP Other (specify): Electricity is provided for my booth’s use: Yes 0 No Camp stove Double steamer Eteetrle §tov© top Stemo & hotel trays Steam table & lids Other (&p©eify) Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. 0 On-site hose bib that is connected to a potable water source. EHD 16-02 7/14/15 Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. am proviomg an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes 0 No _Date(s): I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) □Ta booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. I am providing food that is NOT prepared at home:^ Yes No All food is prepared on-site or is from approved commercial facilities: Yes No Name of facility: /Phone: (1 Address of facility: 1 the following hot temperature control for the hot holding of all potentially hazardous foods above Name of organization/business: Alternate: ( ) t- I'et. the festival coordinator three (3) weeks prior to this event ___ The following is information about my organization/business: